Asian Americans and Diabetes

Asian Americans are almost twice as likely to develop diabetes as the general population in the United States, and of those who develop the disease, more than 95% are diagnosed with type 2 diabetes. Although this form of diabetes can often be treated with diet and exercise, Sophia Cheung, M.S., R.D., L.D.N., and Research Dietitian at The Joslin Diabetes Center, points out that there are still barriers to proper diabetes care for Asian Americans.

The root of the problem

"Traditional Asian cooking is generally low in fat and high in fiber, so it is not hard to introduce healthy cooking strategies to Asian American patients," Cheung states. Instead, "it’s the industrialization of Asian countries that causes dietary shifts—people prefer to eat processed foods that are higher in fat, calories, and even higher in sodium," she explains. This shift from traditional cooking to mainly processed foods means fewer healthy food choices, and ultimately, changes in diet that significantly impact health.

Body composition differences

According to Cheung, important studies that look at prevention and treatment for people with type 2 diabetes use Caucasian patients primarily. "Due to differences in body size, physiology and cultural differences between Asians and Caucasians, results may not be applicable to Asians," she states. A classic example of this, she says, is the body mass index (BMI). "At a lower BMI, Asians tend to accumulate more body fat compared to Caucasians," which she says underscores the need for different BMI thresholds for Asian American patients.

Weight gain isn’t a symptom for many Asians with type 2 diabetes

A telltale symptom of type 2 diabetes is weight gain, but for many Asian Americans, this symptom simply does not appear. The result is that fewer Asian Americans are screened for type 2 diabetes. However, Cheung states that many of the other symptoms type 2 diabetes produces are still present—thirst, frequent urination, and unexplained fatigue. Because weight gain is not often a symptom Asian Americans with type 2 diabetes exhibit, many doctors do not link the other symptoms presented to diabetes, and many remain undiagnosed.

At the Asian American Diabetes Initiative (AADI) at The Joslin Diabetes Center, doctors and dietitians specialize in treating diabetes in Asian Americans, which means an emphasis on culturally sensitive care and nutrition therapy that acknowledges differences.

Patient perspectives on diabetes care

Cheung says that many Asian American patients think treating diabetes means following a specific regimen for a period of time to cure the disease. They believe that certain herbs or Chinese medicines can address the cause of the disease, while western medicine only relieves the symptoms. "Often, these patients will concurrently seek alternative medications or eat large amounts of certain foods--such as pumpkin and bitter melon--while taking their prescribed medications," she states.

When working with patients, Cheung teaches them to think about food differently, and once they’ve learned more about what foods they can eat, "Most are happy and excited that they actually do not have as much restriction to their diet as they originally thought," Cheung states.

Cheung says that many Asian patients refuse the initial consultation with a dietitian because they don’t understand the role of nutrition in managing their diabetes, and adhere to the traditional view that characterizes physicians as the only experts in treating the disease. "I usually spend the first ten minutes of our consultation explaining how certain foods will allow their medication to work better," Cheung states.

Carbohydrate education is followed by a discussion about healthy proteins and fats. Once nutrition education has been completed, Cheung says patients begin to feel comfortable and knowledgeable about choosing healthy food options, and controlling type 2 diabetes.